SW1221003_Application Form_20221031

DEMLR USE ONLY
Date Received
Fee Paid
Permit Number
Applicable Rules: ❑ Coastal SW - 1995 ❑ Coastal SW - 2008 ❑ Ph 11 - Post Construction
(select all that apply) ❑ Non -Coastal SW- HQW/ORW Waters ❑ Universal Stormwater Management Plan
❑ Other WQ Mgmt Plan: . - J
State of North Carolina
Department of Environment and Natural Resources
Division of Energy, Mineral and Land Resources
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
This form nta y be photocopied for use as an original
1. GENERAL INFORMATION
1. Project Name (subdivision, facility, or establishment name - should be consistent with project name on plans,
specifications, letters, operation and maintenance agreements, etc.):
Mills River Townhomes Single -Family Attached Development
2. Location of Project (street address):
2211, 2253 & 2035 leffress Road
City: Mills River County: Henderson Zip: 28759
3. Directions to project (from nearest major intersection):
The main entrance to the development is apl2roximateLy 1190 feet east along effress Road SR-1345
from the major intersection of Boylston Hi hwa NC-280 and Jeffress Road SR-1345 .
4. Latitude: 35 a 23 ' 57 " N Longitude: 82 ° 33' 59 " W of the main entrance to the project.
II. PERMIT INFORMATION:
1. a. Specify whether project is (check one): ®New ❑Modification ❑ Renewal w/ Modificationt
tRenezvals zvitlt modifications also requires 5WU-702 - Renewal Application Forut
b.If this application is being submitted as the result of a modification to an existing permit, list the existing
permit number , its issue date (if known) J and the status of
construction: ❑Not Started ❑Partially Completed* ❑ Completed* *provide a designer's certification
2. Specify the type of project (check one):
❑Low Density ®High Density ❑Drains to an Offsite Stormwater System ❑Other
3. If this application is being submitted as the result of a previously returned application or a letter from
DEMLR requesting a state stormwater management permit application, list the Stormwater project number,
if assigned, and the previous name of the project, if different than currently
proposed,
4. a. Additional Project Requirements (check applicable blanks; information on required state permits can be
obtained by contacting the Customer Service Center at 1-877-623-6748):
❑CAMA Major ®Sedimentation/Erosion Control: 18.0 ac of Disturbed Area
❑NPDES Industrial Stormwater ❑404/401 Permit: Proposed Impacts
b.If any of these permits have already been acquired please provide the Project Name, Project/Permit Number,
issue date and the type of each permit:
Is the project located within 5 miles of a public airport? [:]No ®Yes
If yes, see S.L. 2012-200, Part VI: htt ortal.ttcdenr.or web lr rules -and -re tilations
Form SWU-101 Version Oct. 31, 2013 Page I of 6

III. CONTACT INFORMATION
1. a. Print Applicant / Signing Official's name and title (specifically the developer, property owner, lessee,
designated government official, individual, etc. who owns the project :
Applicant/Organization: Mills RiverTFl LLC
Signing Official & Title: David Benjamin Graves Manager
b, Contact information for person listed in item la above:
Street Address: 1855E Main Street, Ste 14-7
City: Spartanburg State: SC Zip: 29307
Mailing Address (if applicable):
City:
Sta
Phone: (864 ) 210 - 8400 Fax:
Email: rjoa-dan®Iongbranchdevelopment.com
Zip:
Please check the appropriate box. The applicant listed above is:
❑ The property owner (Skip to Contact Information, item 3a)
❑ Lessee* (Attach a copy of the lease agreement and complete Contact Information, item 2a and 2b below)
® Purchaser* (Attach a copy of the pending sales agreement and complete Contact Information, item 2a and
2b below)
® Developer* (Complete Contact Information, item 2a and 2b below.)
2. a. Print Property Owner's name and title below, if you are the lessee, purchaser or developer. (This is the
person who owns the property that the project is located on):
Property Owner/Organization: Franklin Family Trust
Signing Official & Title: Norman Louis Franklin - Trustee
b. Contact information for person listed in item 2a above:
Street Address: 368 Hoo ers Creek Road
City: Fletcher State: NC Zip: 28732
Mailing Address (if
City:
State:
Phone: [phone] Fax:
Ernail:—[e-mail]..
Zip:
3. a. (Optional) Print the name and title of another contact such as the project's construction supervisor or other
person who can answer questions about the project:
Other Contact Person/Organization:
Signing Official &
b. Contact information for person listed in item 3a above:
Mailing Address:
City:
Phone:
Email:
State: Zip:
Fax:
4. Local jurisdiction for building permits: Henderson County
Point of Contact: Sarabeth Deluca Phone #: ( 828 ) 697 - 4830
Form SWU-101 Version Oct. 31, 2013 Page 2 of 6

IV. PROJECT INFORMATION
1. In the space provided below, briefly summarize how the stormwater runoff will be treated.
Stormwater will be treated through appropriately sized Ba Filter Systems for each BMP.
2. a. If claiming vested rights, identify the supporting documents provided and the date they were approved:
❑ Approval of a Site Specific Development Plan or PUD Approval Date:
❑ Valid Building Permit Issued Date:
❑ Other: Date:
b.If claiming vested rights, identify the regulation(s) the project has been designed in accordance with:
❑ Coastal SW -1995 ❑ Ph II - Post Construction
3. Stormwater runoff from this project drains to the French Broad River basin.
4. Total Property Area: 37.001 acres
5. Total Coastal Wetlands Area: 0.0 acres
6. TotaI Surface Water Area: 0.194 acres
7. Total Property Area (4) -Total Coastal Wetlands Area (5) -Total Surface Water Area (6) = Total Project
Area+: 36.807 acres
+ Total project area shall be calculated to exclude thefollowing: the norrna2 pool of unpounded structures, the area
behoeen the batiks of streaajrs and rivers, the area belozv the Normal High Water (NHW) line or Meair High Water
(MHW) line, acid coastal zvetlmds landward frotie the NHW (or MHW) Iine. The resultant project area is used to
calculate overall percent built upon area (BUA). Nori-coastal zvetlands landward of the NHW (or MHW) lure tnay
be included in the total project area.
8. Project percent of impervious area: (Total. Impervious Area / Total Project Area) X 100 = 23.3
9. How many drainage areas does the project have? 3 (For high densihj, count 1 for each proposed engineered
stornzzvater BMP. For iozv density and other projects, itse 1 for the zohole property area)
10. C omplete the following information for each drainage area identified in Project Information item 9. If there
are more than four drainage areas in the project, attach an additional sheet with the information for each area
provided in the same format as below.
Basin Information
Drainage Area 1
Drainage Area 2
Drainage Area 3
Drainage Area
Receiving Stream Name
Hollaman Lake
Hollaman Lake
Hollaman Lake
Stream Class *
C
C
C
Stream Index Number *
6-56
6-56
6-56
Total Drainage Area (so
229,334
158,200
142,327
On -site Drainage Area (so
229,334
158,200
142,327
Off -site Drainage Area (sf)
0
0
0
Proposed Impervious Area** (so
147,233
126,899
99,871
Impervious Area** total
64.2%
80.2%
70.2%
Impervious' Surface Area
Drainage Area 1
Drainage Area 2
Drainage Area 3
Drainage Area u
On -site B"ik4i"M/Lots (so
66,204
83,145
58,727
On -site Skw*4o (sf) ROW
53,625
43,754
25,170
On -site Parking (so
N/A
N/A
N/A
On -site Sidewalks (sf)
N/A
N/A
N/A
Other on -site (sf) Amenities
0
0
15,974
Future (so
N/A
N/A
N/A
Off -site (sf)
N/A
N/A
N/A
Existing BUA*** (so
0
0
0
Total (so:
1 147,233
1 126,899
1 99,871
Streatn Class acid Index Number can be deterruuied at: littp.aortal.nedertr.or Avg eb/wg&s/cstc%lassificatiotts
lilt ervious area is defined as the bitilt itpoti area including, bat not Iimited to, buildings, roads, parking areas,
sidezvalks, gravel areas, etc.
Forrn SWU-101 Version Oct. 31, 2013 Page 3 of 6

'*Report only that amount of existing BUA that will remain after development, Do not report any existing BUA that
is to be removed and which will be replaced by new BUA.
11. How was the off -site impervious area listed above determined? Provide documentation. N/A. All off -site
imi2ervious area is prol2osed to be rerouted around the proj2osed SMP's.
Projects in Union County: Contact DEMLR Central Office staff to check if 1he project is located tivilhin a Threatened &
Endangered Species watershed that may be subject to more stringent stormwater requirements as per 15A NCAC 02B .0600.
V. SUPPLEMENT AND O&M FORMS
The applicable state stormwater management permit supplement and operation and maintenance (O&M) forms
must be submitted for each BMP specified for this project. The latest versions of the forms can be downloaded
from htt portal.ncdetir.org/iveb/ wq /ws/su/brnp-mallUal.
VI. SUBMITTAL REQUIREMENTS
Only complete application packages will be accepted and reviewed by the Division of Energy, Mineral and
Land Resources (DEMLR). A complete package includes all of the items listed below. A detailed application
instruction sheet and BMP checklists are available from
htt ortal.iicdenr.or web w vvs stistatesw forms does. The complete application package should be
submitted to the appropriate DEMLR Office. (The appropriate office may be found by locating project on the
interactive online map at litt ortal.ncdenr.or web w ws su ina s.)
Please indicate that the following required information have been provided by initialing in the space provided
for each item. All original documents MUST be signed and initialed in blue ink. Download the latest versions
for each submitted application package from litt.p://portal.ncdenr.org/rveb/wq/ws/su/statesw/forins does.
Initials
1. Original and one copy of the Stormwater Management Permit Application Form. - /P 1/1, e
2. Original and one copy of the signed and notarized Deed Restrictions & Protective Covenants '✓-'I GS
Form. (if required as per Part VII below)
3. Original of the applicable Supplement Form(s) (sealed, signed and dated) and O&M
agreement(s) for each BMP.
4. Permit application processing fee of $505 payable to NCDENR. (For an Express review, refer to
httl2://www.envheII2.org/12ages/oriesto]2express.htrffl for information on the Express program
and the associated fees. Contact the appropriate regional office Express Permit Coordinator for
additional information and to schedule the required application meeting.)
5. A detailed narrative (one to two pages) describing the stormwater treatment/management
6. A USGS map identifying the site location. If the receiving stream is reported as class SA or the
receiving stream drains to class SA waters within 1/2 mile of the site boundary, include the 1/2
mile radius on the map.
7. Sealed, signed and dated calculations (one copy).
8. Two sets of plans folded to 8.5" x 14" (sealed, signed, & dated), including:
a. Development/Project name.
b. Engineer and firm.
c. Location map with named streets and NCSR numbers.
d. Legend.
e. North arrow.
f. Scale.
g. Revision number and dates.
h. Identify all surface waters on the plans by delineating the normal pool elevation of
impounded structures, the banks of streams and rivers, the MHW or NHW line of tidal
waters, and any coastal wetlands landward of the MHW or NHW lines.
• Delineate the vegetated buffer landward from the normal pool elevation of impounded
structures, the banks of streams or rivers, and the MHW (or NHW) of tidal waters.
i. Dimensioned property/project boundary with bearings & distances.
j. Site Layout with all BUA identified and dimensioned.
k. Existing contours, proposed contours, spot elevations, finished floor elevations.
1. Details of roads, drainage features, collection systems, and stormwater control measures.
m. Wetlands delineated, or a note on the plans that none exist. (Must be delineated by a
qualified person. Provide documentation of qualifications and identify the person who
made the determination on the plans.
n. Existing drainage (including off -site), drainage easements, pipe sizes, runoff calculations.
o. Drainage areas delineated (included in the main set of plans, not as a separate document).
for
Form SWU-101 Version Oct. 31, 2013 Page 4 of 6

p. Vegetated buffers (where required).rb-
9. Copy of any applicable soils report with the associated SHWT elevations (Please identify
elevations in addition to depths) as well as a map of the boring locations with the existing
elevations and boring logs. Include an 8.5"xll" copy of the NRCS County Soils map with the
project area clearly delineated. For projects with infiltration BMPs, the report shouldd also
include the soil type, expected infiltration rate, and the method of determining the infiltration rate.
(Infiltration Devices submitted to WiRO: Schedule a site visit for DEMLR to verifij the SHWT prior
to submittal, [phone].) �C p
10. A copy of the most current property deed. Deed book: 3837 Page No: 512
11. For corporations and limited liability corporations (LLC): Provide documentation from the NC L
Secretary of State or other official documentation, which supports the titles and positions held
by the persons listed in Contact Information, item la, 2a, and/or 3a per 15A NCAC 2H.1003(e).
The corporation or LLC must be listed as an active corporation in good standing with the NC
Secretary of State, otherwise the application will be returned.
http, / /www.secretary.state.itc.us/Corl2orations/CSearch.aspx
VII. DEED RESTRICTIONS AND PROTECTIVE COVENANTS
For all subdivisions, outparcels, and future development, the appropriate property restrictions and protective
covenants are required to be recorded prior to the sale of any lot. If lot sizes vary significantly or the proposed
BUA allocations vary, a table listing each lot number, lot size, and the allowable built -upon area must be
provided as an attachment to the completed and notarized deed restriction form, The appropriate deed
restrictions and protective covenants forms can be downloaded from litt�i://portal.iicdeiir.org/iveb/ii-/state-
stormwater-forms does. Download the latest versions for each submittal.
In the instances where the applicant is different than the property owner, it is the responsibility of the property
owner to sign the deed restrictions and protective covenants form while the applicant is responsible for ensuring
that the deed restrictions are recorded.
By the notarized signature(s) below, the permit holder(s) certify that the recorded property restrictions and
protective covenants for this project, if required, shall include all the items required in the permit and listed
on the forms available on the website, that the covenants will be binding on all parties and persons claiming
under them, that they will run with the land, that the required covenants cannot be changed or deleted
without concurrence from the NC DEMLR, and that they will be recorded prior to the sale of any lot.
VIII. CONSULTANT INFORMATION AND AUTHORIZATION
Applicant: Complete this section if you wish to designate authority to another individual and/or firm (such as a
consulting engineer and/or firm) so that they may provide information on your behalf for this project (such as
addressing requests for additional information).
Consulting Engineer: Mark Brooks PE
Consulting Firm: Brooks Engineering Associates PA
Mailing Address:15 Arlington Street
City: Asheville
Phone: 828 232 - 4700
Email: mbrooks®brooksea.com
State: NC Zip: 28801
Fax: ( 828 ) 232 -1331
IX. PROPERTY OWNER AUTHORIZATION (if Contact Information, item 2 has been filled oast, complete this
section)
1, (print or type name of person listed in Contact Information, item 2a) Norman Louis Franklin certify that I
own the property identified in this permit application, and thus give permission to (print or type name of person
listed in Contact Information, item 1a) David Benjamin Graves with (print or
type name of organization listed in Contact Information, item 1a) Mills River TH, LLC to develop the
project as currently proposed. A copy of the lease agreement or pending property sales contract has been
provided with the submittal, which indicates the party responsible for the operation and maintenance of the
stormwater system.
Form SWU-101 Version Oct. 31, 2013 Page 5 of 6

As the legal property owner I acknowledge, understand, and agree by my signature below, that if my designated
agent (entity listed in Contact Information, item 1) dissolves their company and/or cancels or defaults on their
Iease agreement, or pending sale, responsibility for compliance with the DEMLR Stormwater permit reverts back
to me, the property owner. As the property owner, it is my responsibility to notify DEMLR immediately and
submit a completed Name/ Ownership Change Form within 30 days; otherwise I will be operating a stormwater
treatment facility without a valid permit. I understand that the operation of a stormwater treatment facility
without a valid permit is a violation of NC General Statue 143-215.1 and may result in appropriate enforcement
action including the assessment of civil penalties of up to $25/000 per day, pursuant to NCGS 143-215.6.
Date: 1U -- e " ;Zf--, -�'
a Notary Public for the State of / V County of , -
do hereby certify that C personally appeared
before me this day ofZ912'and ac wledg the due exe ution of the application for
a stormwater permit. Witness my hand and official seal,
0WiilFJ4eme
lice
JYatacr;�ualic
Lem� � 2026
X. APPLICANT'S CERTIFICATION
SEAL
My commission expires 6 zeup
I, (print or hype name of person listed in Contact Information, item 1a) David Ben'antin Graves
certify that the information included on this permit application form is, to the best of my knowledge, correct and
that the project will be constructed in conformance with the approved plans, that the required deed restrictions
and protective covenants will be recorded, and that the proposed project complies with the requirements of the
applicable stormwater rules under 15A NCAC 2H .1000 and any other applicable state stormwater requirements
Signature: Date:
a Notary Public for the State of , County of
do hereby certify that
personally appeared
before me this _ day of , and acknowledge the due execution of the application for
a stormwater permit. Witness my hand and official seal,
SEAL
My commission expires,
Form SWU-101 Version Oct, 31, 2013 Page 6 of 6

As the legal property owner 1 acknowledge, understand, and agree by my signature below, that if my designated
agent (entity listed in Contact Information, item 1) dissolves their company and/or cancels or defaults on their
lease agreement, or pending sale, responsibility for compliance with the DEMLR Stormwater permit reverts back
to me, the property owner. As the property owner, it is my responsibility to notify DEMLR immediately and
submit a completed Name/Ownership Change Form within 30 days; otherwise I will be operating a stormwater
treatment facility without a valid permit. I understand that the operation of a stormwater treatment facility
without a valid permit is a violation of NC General Statue 143-215.1 and may result in appropriate enforcement
action including the assessment of civil penalties of up to $25,000 per day, pursuant to NCGS 143-215.6.
a Notary Public for the State of
do hereby certify that
before me this _ day of
Date:
County of
personally appeared
and acknowledge the due execution of the application for
a stormwater permit. Witness my hand and official seal,
SEAL
My commission
X. APPLICANT'S CERTIFICATION
I, (print or type nariie of person lasted in Contact Information, iteln 1a) David Benjamin Graves
certify that the information included on this permit application form is, to the best of my knowledge, correct and
that the project will be constructed in conformance with the approved plans, that the required deed restrictions
and protective co enants will be recorded, and that the proposed project complies with the requirements of the
applicable storr,q�r rtiAes under 15A NCAC 2H .1000 and any other applicable state stormwater requirements.
Date: I ID 1 S ZZ
1 �`'� Y1c1(` %'[ • �+ y+� S a Notary Public for the State of S-OVA�CCLv1D vle— County of
oWv do hereby certify that13kU- Zsi��,�m•r. C�YGtyt S personally appeared
before me this � ay of ()f ,�O\ljPN -ZD ZZ and aclnowledgVv e the due execution of �tl�e application for
a stormwater permit. Witness my hand and official seal, ` JaAll-&-1
wOTARy M
SEAT.
My commission expires ' 0 1 1-1 1 2-b Z
Form SWU-101 Version Oct. 31, 2013 Page 6 of 6

DEMLR USE ONLY
Date Received
Fee Paid
Permit Number
Applicable Rules: ❑ Coastal SW - 1995 ❑ Coastal SW - 2008 ❑ Ph II - Post Construction
(select all that apply) ❑ Non -Coastal SW- HQW/ORW Waters ❑ Universal Stormwater Management Plan
❑ Other WQ Mgmt Plan:
State of North Carolina
Department of Environment and Natural Resources
Division of Energy, Mineral and Land Resources
STORMWATER MANAGEMENT PERMIT APPLICATION FORM
This forur ntay be photocopied for use as an original
I. GENERAL INFORMATION
1. Project Name (subdivision, facility, or establishment name - should be consistent with project name on plans,
specifications, letters, operation and maintenance agreements, etc.):
Mills River Townhomes Single -Family Attached Development _
2. Location of Project (street address):
2211, 22533 & 2035 ieffress Road
City: Mills River County: Henderson Zip: 28759
3. Directions to project (from nearest major intersection):
The main entrance to the development is Qproximate!y 1,190 feet east along effress Road SR-1345
from the major intersection of Boylston Highway NC-280 and Jeffress Road SR-1345 .
4. Latitude: 35 ° 23' 57" N Longitude: 82 ' 33' 59" W of the main entrance to the project.
II. PERMIT INFORMATION:
1. a. Specify whether project is (check one): ®New ❑Modification ❑ Renewal w/ Modificationt
tRenezvals witli modifications also requires SYVU-102 - Reneival Application Form
b. If this application is being submitted as the result of a modification to an existing permit, list the existing
permit number , its issue date (if known) , and the status of
construction: ❑Not Started ❑Partially Completed* ❑ Completed* *provide a designer's certification
2. Specify the type of project (check one):
❑Low Density ®High Density ❑Drains to an Offsite Stormwater System ❑Other
3. If this application is being submitted as the result of a previously returned application or a letter from
DEMLR requesting a state stormwater management permit application, list the stormwater project number,
if assigned, and the previous name of the project, if different than currently
proposed,
4. a. Additional Project Requirements (check applicable blanks; information on required state permits can be
obtained by contacting the Customer Service Center at 1-877-623-6748):
❑LAMA Major ®Sedimentation/Erosion Control: 18.0 ac of Disturbed Area
❑NPDES Industrial Stormwater ❑404/401 Permit: Proposed Impacts
b. If any of these permits have already been acquired please provide the Project Name, Project/Permit Number,
issue date and the type of each permit:
Is the project located within 5 miles of a public airport? [:]No ®Yes
If yes, see S.L. 2012-200, Part VI: htt r ortal.ncdenr.or %veb lr rules -anti -re ulations
Fond SWU-101 Version Oct. 31, 2013 Page I of

III. CONTACT INFORMATION
1. a. Print Applicant / Signing Official's name and title (specifically the developer, property owner, lessee,
designated government official, individual, etc. who owns the project):
Applicant/Organization: Mills River TH, LLC
Signing Official & Title: David Benjamin Graves Manager
b.Contact information for person listed in item 1a above:
Street Address:1855 E. Main Street Ste 14-7
City: Spartanburg.. State: SC Zip: 29307
Mailing Address (if applicable):
City: State:
Phone: 864 210 - 8400 Fax:
Email: [e-mail]
Zip:
c. Please check the appropriate box. The applicant listed above is:
❑ The property owner (Skip to Contact Information, item 3a)
❑ Lessee* (Attach a copy of the lease agreement and complete Contact Information, item 2a and 2b below)
® Purchaser* (Attach a copy of the pending sales agreement and complete Contact Information, item 2a and
2b below)
® Developer* (Complete Contact Information, item 2a and 2b below.)
2. a. Print Property Owner's name and title below, if you are the lessee, purchaser or developer. (This is the
person who owns the property that the project is located on):
Property Owner/Organization: Calvary Fellowship of Western North Carolina, Inc.
Signing Official & Title: Noel Hendrix Registered Agent
b.Contact information for person listed in item 2a above:
Street Address: 2035 leffress Road
City: Mills River
Mailing Address (if applicable):
State: NC
City: State:
Phone: (828 ) 713-7825 Fax:
Email: [e-mail]
Zip:28759
Lip:
3. a. (Optional) Print the name and title of another contact such as the project's construction supervisor or other
person who can answer questions about the project:
Other Contact Person/Organization:
Signing Official & Title:
b. Contact information for person listed in item 3a above:
Mailing A
City: State:
Phone: l ) Fax:
Zip:
4. Local jurisdiction for building permits: Henderson County
Point of Contact: Sarabeth Deluca Phone #: ( 828 ) 697 - 4830
Form SWU-101 Version Oct. 31, 2013 Page 2 of 6

IV. PROJECT INFORMATION
1. In the space provided below, briefly summarize how the stormwater runoff will be treated.
Stormwater will be treated through appropriately sized BayFilter Systems for each BMP.
2. a. If claiming vested rights, identify the supporting documents provided and the date they were approved:
❑ Approval of a Site Specific Development Plan or PUD Approval Date:
❑ Valid Building Permit Issued Date:
❑ Other: Date:
b.If claiming vested rights, identify the regulation(s) the project has been designed in accordance with:
❑ Coastal SW - 1995 ❑ Ph II - Post Construction
3. Stormwater runoff from this project drains to the French Broad River basin.
4. Total Property Area: 37.001 acres
5. Total Coastal Wetlands Area: 0.0 acres
6. Total Surface Water Area: 0.194 acres
7. Total Property Area (4) -Total Coastal Wetlands Area (5) -Total Surface Water Area (6) = Total Project
Area+: 36.807 acres
+ Total project area shall be calculated to exchtde the following: the normal pool of impounded structures, the area
between the banks of streams and rivers, the area belozo the Normal High Water (NHW) Iine or Mean High Water
(MHW) line, and coastal zvetla)ids landward frotat the NHW (or MHM Iine. The resid taut project area is used to
calculate overall percent built atpo)z area (B CIA). Non -coastal wettatids IaMward of the NHW (or MHW) line may
be inchided iii the total project area.
8. Project percent of impervious area: (Total Impervious Area / Total Project Area) X 100 = 23.3 %
9. How many drainage areas does the project have? 3 (For high density, count I for each proposed engineered
stornnvater BMP. For lozo density and other projects, itse I for the whole property area)
10. C omplete the following information for each drainage area identified in Project Information item 9. If there
are more than four drainage areas in the project, attach an additional sheet with the information for each area
provided in the same format as below.
Basin Information
Drainage Area 1
Drainage Area 2
Drainage Area 3
Drainage Area _
Receiving Stream Name
Hollaman Lake
Hollaman Lake
Hollaman Lake
Stream Class *
C
C
C
Stream Index Number *
6-56
6-56
6-56
Total Drainage Area (so
229,334
158,200
142,327
On -site Drainage Area (so
229,334
158,200
142,327
Off -site Drainage Area (so
0
0
0
Proposed Impervious Area** (so
147,233
126,899
99,871
% Impervious Area** total
64.2%
80.2%
70.2%
Impervious' Surface Area
Drainage Area 1
Drainage Area 2
Drainage Area 3
Drainage Area _
On -site rM/Lots (so
66,204
83,145
58,727
On -site gk"Mso (sf) ROW
53,625
433,754
25,170
On -site Parking (sf)
N/A
N/A
N/A
On -site Sidewalks (sf)
N/A
N/A
N/A
Other on -site (sf) Amenities
0
0
15,974
Future (so
N/A
N/A
N/A
Off -site (so
N/A
N/A
N/A
Existing BUA*** (sf)
0
0
0
Total (so:
147,233
126,899
99,871
* Stream Class and Index Nuinber can be detemihied at: littp.Aortal.ludeitr.or eblzoq&s/cstiAlassi catloils
faatppervious area is defined as the built upon area including, but Trot Iintited to, buildings, roads, parking areas,
sidezoalks, gravel areas, etc.
Form SV U-101 Version Oct. 31, 2013 Page 3 of

*** Report only that aniount of existing BUA that zoill reaiain after developnient. Do not report any existing BUA that
Is to be reproved and which will be replaced by new B UA.
11. How was the off -site impervious area listed above determined? Provide documentation, N/A. All off -site
impervious area is proposed to be rerouted around the proposed BMP's.
Pro'ects in Union County: Contact DEMLR Central Office staff to check if the project is located within a Threatened &
Endangered Species ivatei-shed that )nay be subject to more stringent slornnmfer requirements as per 15A NCAC 02B .0600.
V. SUPPLEMENT AND O&M FORMS
The applicable state stormwater management permit supplement and operation and maintenance (O&M) forms
must be submitted for each BMP specified for this project. The latest versions of the forms can be downloaded
from littp://partaLncdenr.org/web/wq/WS/sLi/bmp-manual.
VI. SUBMITTAL REQUIREMENTS
Only complete application packages will be accepted and reviewed by the Division of Energy, Mineral and
Land Resources (DEMLR). A complete package includes all of the items listed below. A detailed application
instruction sheet and BMP checklists are available from
littp://portal.ncdeiii-.org/web/wq/wsLsu/statesw/foi-i-ns does. The complete application package should be
submitted to the appropriate DEMLR Office. (The appropriate office may be found by locating project on the
interactive online map at htt : L)ortal.ncdenr.or tveb w ws su ma s.)
Please indicate that the following required information have been provided by initialing in the space provided
for each item. All original documents MUST be signed and initialed in blue ink. Download the latest versions
for each submitted application package from littp://portal.ncLienr.org/web/wq/wsZsu/statesw/forms does.
Inih'aJsa
1. Original and one copy of the Stormwater Management Permit Application Form. -07C,,. )
2. Original and one copy of the signed and notarized Deed Restrictions & Protective Covenants
Form. (if required as per Part VII below)
3. Original of the applicable Supplement Form(s) (sealed, signed and dated) and O&M
agreement(s) for each BMP.
4. Permit application processing fee of $505 payable to NCDENR. (For an Express review, refer to
htW://www,envhelI2.org/pages/onestopexRress.html for information on the Express program
and the associated fees. Contact the appropriate regional office Express Permit Coordinator for
additional information and to schedule the required application meeting.)
5. A detailed narrative (one to two pages) describing the stormwater treatment/management
& A USGS map identifying the site location. If the receiving stream is reported as class SA or the
receiving stream drains to class SA waters within 1/2 mile of the site boundary, include the
mile radius on the map.
7. Sealed, signed and dated calculations (one copy).
8. Two sets of plans folded to 8.5" x 14" (sealed, signed, & dated), including:
a. Development/Project name.
b. Engineer and firm.
c. Location map with named streets and NCSR numbers.
d. Legend.
e. North arrow.
f. Scale.
g, Revision number and dates.
h. Identify all surface waters on the plans by delineating the normal pool elevation of
impounded structures, the banks of streams and rivers, the MEW or NHW line of tidal
waters, and any coastal wetlands landward of the MHW or NEW Iines.
• Delineate the vegetated buffer landward from the normal pool elevation of impounded
structures, the banks of streams or rivers, and the MHW (or NEW) of tidal waters.
i. Dimensioned property/project boundary with bearings & distances.
j. Site Layout with all BUA identified and dimensioned,
k. Existing contours, proposed contours, spot elevations, finished floor elevations.
1. Details of roads, drainage features, collection systems, and stormwater control measures.
m. Wetlands delineated, or a note on the plans that none exist. (Must be delineated by a
qualified person. Provide documentation of qualifications and identify the person who
made the determination on the plans.
n, Existing drainage (including off -site), drainage easements, pipe sizes, runoff calculations.
o. Drainage areas delineated (included in the main set of plans, not as a separate document).
for, /V
Form SWU-101 Version Oct. 31, 2013 Page 4 of 6

p. Vegetated buffers (where required). n��
Copy of any applicable soils report with the associated SHWT elevations (Please identify I/'/
elevations in addition to depths) as well as a map of the boring locations with the existing
elevations and boring logs. Include an 8.5"x11" copy of the NRCS County Soils map with the
project area clearly delineated. For projects with infiltration BMPs, the report should also
include the soil type, expected infiltration rate, and the method of determining the infiltration rate.
(Infiltration Devices submitted to WiRO: Schedule a site visit for DEMLR to vertfij the SHWT prior
to snbtnitfal, (9I0) 795-7378.)
A copy of the most current property deed. Deed book: 1438 Page No: 656
For corporations and limited liability corporations (LLC): Provide documentation from the NC
Secretary of State or other official documentation, which supports the titles and positions held
by the persons listed in Contact Information, item 1a, 2a, and/or 3a per 15A NCAC 21-1.1003(e).
The corporation or LLC must be listed as an active corporation in good standing with the NC
Secretary of State, otherwise the application will be returned.
http:/ /www.secretary.state.nc,us/Corporations/CSearch.aspx
VII. DEED RESTRICTIONS AND PROTECTIVE COVENANTS
For all subdivisions, outparcels, and future development, the appropriate property restrictions and protective
covenants are required to be recorded prior to the sale of any lot. If lot sizes vary significantly or the proposed
BUA allocations vary, a table listing each lot number, lot size, and the allowable built -upon area must be
provided as an attachment to the completed and notarized deed restriction form. The appropriate deed
restrictions and protective covenants forms can be downloaded from http:///12ortal,iudenr.org/web/ir/state-
stormi•vater-forms does. Download the latest versions for each submittal.
In the instances where the applicant is different than the property owner, it is the responsibility of the property
owner to sign the deed restrictions and protective covenants form while the applicant is responsible for ensuring
that the deed restrictions are recorded.
By the notarized signature(s) below, the permit holder(s) certify that the recorded property restrictions and
protective covenants for this project, if required, shall include all the items required in the permit and listed
on the fortes available on the website, that the covenants will be binding on all parties and persons claiming
under them, that they will run with the land, that the required covenants cannot be changed or deleted
without concurrence from the NC DEMLR, and that they will be recorded prior to the sale of any lot.
VIII. CONSULTANT INFORMATION AND AUTHORIZATION
Applicant: Complete this section if you wish to designate authority to another individual and/or firm (such as a
consulting engineer and/or firm) so that they may provide information on your behalf for this project (such as
addressing requests for additional information).
Consulting Engineer: Mark Brooks PE
Consulting Firm: Brooks Engteering Associates PA
Mailing Address:15 Arlington Street
City: Asheville
Phone: ( 828 ) 232 - 4700
Email: [e-mail]
State: NC Zip: 28801
Fax: ( 828 ) 232 -1331
IX. PROPERTY OWNER AUTHORIZATION (if Contact Information, item 2 has been filled out, complete this
section)
I, (print or type natne of person listed in Contact Information, item 2a) Noel Hendrix certify that I
own the property identified in this permit application, and thus give permission to (print or type name of person
listed in Contact Information, ifettt 1a) David Bettjmnin Graves with (print or
type name of organization Iisted in Contact Information, pent 1a) Mills River TH, LLC to develop the
project as currently proposed. A copy of the Iease agreement or pending property sales contract has been
provided with the submittal, which indicates the party responsible for the operation and maintenance of the
stormwater system.
Form SWIJ-101 Version Oct. 31, 2013 Page 5 of

As the legal property owner 1 acknowledge, understand, and agree by my signature below, that if my designated
agent (entity listed in Contact Information, item 1) dissolves their company and/or cancels or defaults on their
lease agreement, or pending sale, responsibility for compliance with the DEMLR Stormwater permit reverts back
to me, the property owner. As the property owner, it is my responsibility to notify DEMLR immediately and
submit a completed Name/Ownership Change Form within 30 days; otherwise I will be operating a stomrwater
treatment facility without a valid permit. I understand that the operation of a stormwater treatment facility
without a valid permit is a violation of NC General Statue 143-215.1 and may result in appropriate enforcement
action including the assessment of civil palties of up to $25,000 per day, pursuant to NCGS 143-215.6.
before me this Z day
a stormwater permit.
P Date-
fL 1r' Notary Public for the State of � County of
, do hereby certify that......&e.1jlJrx personally appeared
of �/C o {SPY, and acknowledge the due execution of Pe application for
Witness my hand and official seal,
SEAL
My commission expires _a , 7: -- 17Q-r2_. ] -_
X. APPLICANT'S CERTIFICATION
1, (print or type name of person listed in Contact Information, item 1a) David Ben antin Graves
certify that the information included on this permit application form is, to the best of my knowledge, correct and
that the project will be constructed in conformance with the approved plans, that the required deed restrictions
and protective covenants will be recorded, and that the proposed project complies with the requirements of the
applicable stormwater rules under 15A NCAC 2H .1000 and any other applicable state stormwater requirements.
Signature:
a Notary Public for the State of _ . County of
do hereby certify that personally appeared
before me this T day of _ , _ , and acknowledge the due execution of the application for
a stormwater permit. Witness my hand and official seal,
SEAL
My commission
Form SWU-101 Version Oct, 31, 2013 Page 6 of 6

As the legal property owner I acknowledge, understand, and agree by my signature below, that if my designated
agent (entity listed in Contact Information, item 1) dissolves their company and/or cancels or defaults on their
lease agreement, or pending sale, responsibility for compliance with the DEMLR Stormwater permit reverts back
to me, the property owner. As the property owner, it is my responsibility to notify DEMLR immediately and
submit a completed Name/Ownership Change Form within 30 days; otherwise I will be operating a stormwater
treatment facility without a valid permit. I understand that the operation of a stormwater treatment facility
without a valid permit is a violation of NC General Statue 143-215.1 and may result in appropriate enforcement
action including the assessment of civil penalties of up to $25,000 per day, pursuant to NCGS 143-215.6.
a Notary Public for the State of , County of
do hereby certify that
personally appeared
before me this — day of , and acknowledge the due execution of the application for
a stormwater permit. Witness my hand and official seal,
SEAL
My commission expires
X. APPLICANT'S CERTIFICATION
I, (print or type name of person listed in Contact Information, item Ia) David Benjamin Graves
certify that the information included on this permit application form is, to the best of my knowledge, correct and
that the project will be constructed in conformance with the approved plans, that the required deed restrictions
and protective covenants will be recorded, and that the proposed project complies with the requirements of the
applicable storWayr rAes under 15A NCAC 2H .1000 and any other applicable state stormwater requirements.
Signature:
Date: 1--. � % `"ZO ZZ
a Notary Public for the State ofSD VYk �h \7 �, County of
do herebyy certify that'PCk11' d- DCK' 1ft Mil U �((i Uts personally appeared
before me this ay of �s.�be,✓ L^� and acknowledge the duee��executil execution the application or
a stormwater permit. Witness my hand and official seal, V�yv
gv MOTARy
PUBLIC
♦i'fr�j�r� �,4k,,y
C A'A �a
11111 t k %l%%�.
0W.11I
My commission expires l D 1 1 -7' 27J Zip
Form SWU-101 Version Oct. 3 t, 2013 Page 6 of 6